Toxic shock syndrome: Difference between revisions
From IDWiki
m (Aidan moved page Toxic shock syndromes to Toxic shock syndrome over redirect) |
No edit summary |
||
(5 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
+ | == Background == |
||
− | * Severe septic shock caused by certain bacterial infections |
+ | * Severe septic shock caused by certain bacterial infections, primarily ''[[Staphylococcus aureus]]'' and ''[[Streptococcus pyogenes]]'' |
+ | ** Caused by superantigens, which non-specifically activate a massive number of T-cells |
||
+ | *Similar syndrome can be caused by toxin production of [[Clostridial toxic shock syndrome|''Clostridium sordelli'']] |
||
== Criteria == |
== Criteria == |
||
− | |||
{| class="wikitable" |
{| class="wikitable" |
||
! Criteria |
! Criteria |
||
− | ! Staphylococcal |
+ | ! [[Staphylococcal toxic shock syndrome|Staphylococcal]] |
− | ! Streptococcal |
+ | ! [[Streptococcal toxic shock syndrome|Streptococcal]] |
|- |
|- |
||
| Confirmed |
| Confirmed |
||
Line 57: | Line 59: | ||
|} |
|} |
||
+ | == Management == |
||
− | == Staphylococcal Toxic Shock Syndrome == |
||
+ | {| class="wikitable" |
||
− | |||
+ | ! |
||
− | Source: [https://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/ CDC case definition 2011] |
||
+ | !First-Line |
||
− | |||
+ | !Beta-lactam Allergy |
||
− | === Clinical Criteria === |
||
+ | !Notes |
||
− | |||
+ | |- |
||
− | An illness with the following clinical manifestations: |
||
+ | |[[Streptococcus pyogenes]] |
||
− | |||
+ | |[[Penicillin G]] and [[clindamycin]] |
||
− | * '''Fever:''' temperature greater than or equal to 102.0°F (greater than or equal to 38.9°C) |
||
+ | |[[Macrolide]] or [[fluoroquinolone]], and [[clindamycin]] |
||
− | * '''Rash:''' diffuse macular erythroderma |
||
+ | |Macrolide and fluoroquinolone resistance increasing |
||
− | * '''Desquamation:''' 1-2 weeks after onset of rash |
||
+ | |- |
||
− | * '''Hypotension:''' systolic blood pressure less than or equal to 90 mm Hg for adults or less than fifth percentile by age for children aged less than 16 years |
||
+ | |MLS-resistant [[Streptococcus pyogenes]] |
||
− | * '''Multisystem involvement''' (three or more of the following organ systems): |
||
+ | |[[Penicillin G]], and [[vancomycin]] or [[teicoplanin]] |
||
− | ** '''Gastrointestinal:''' vomiting or diarrhea at onset of illness |
||
+ | |[[Vancomycin]] or [[teicoplanin]] |
||
− | ** '''Muscular:''' severe myalgia or creatine phosphokinase level at least twice the upper limit of normal |
||
+ | |Macrolide resistance associated with clindamycin resistance |
||
− | ** '''Mucous membrane:''' vaginal, oropharyngeal, or conjunctival hyperemia |
||
+ | |- |
||
− | ** '''Renal:''' blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (greater than or equal to 5 leukocytes per high-power field) in the absence of urinary tract infection |
||
+ | |Methicillin-susceptible [[Staphylococcus aureus]] |
||
− | ** '''Hepatic:''' total bilirubin, alanine aminotransferase enzyme, or asparate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory |
||
+ | |[[Cloxacillin]] or [[nafcillin]] or [[cefazolin]], and [[clindamycin]] |
||
− | ** '''Hematologic:''' platelets less than 100,000/mm3 |
||
+ | |[[Clarithromycin]] and [[clindamycin]] |
||
− | ** '''Central nervous system:''' disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent |
||
+ | | |
||
− | |||
+ | |- |
||
− | === Laboratory Criteria for Diagnosis === |
||
+ | |Methicillin-resistant [[Staphylococcus aureus]] |
||
− | |||
+ | |[[Clindamycin]] or [[linezolid]], and [[vancomycin]] or [[teicoplanin]] |
||
− | Negative results on the following tests, if obtained: |
||
+ | | |
||
+ | | |
||
+ | |- |
||
+ | |Glycopeptide resistant or intermediate [[Staphylococcus aureus]] |
||
+ | |[[Linezolid]] and [[clindamycin]] (if susceptible) |
||
+ | | |
||
+ | |Incidence increasing. Geographical patterns highly variable |
||
+ | |} |
||
+ | == Further Reading == |
||
− | * Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus) |
||
− | * Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles |
||
+ | * Gram-positive toxic shock syndromes. ''Lancet Infect Dis''. 2009;9(5):281-290. doi: [https://doi.org/10.1016/S1473-3099(09)70066-0 10.1016/S1473-3099(09)70066-0] |
||
− | === Case Classification === |
||
+ | [[Category:Infectious syndromes]] |
||
− | * Probable: A case which meets the laboratory criteria and in which four of the five clinical criteria described above are present |
||
− | * Confirmed: A case which meets the laboratory criteria and in which all five of the clinical criteria described above are present, including desquamation, unless the patient dies before desquamation occurs |
Latest revision as of 10:34, 22 November 2022
Background
- Severe septic shock caused by certain bacterial infections, primarily Staphylococcus aureus and Streptococcus pyogenes
- Caused by superantigens, which non-specifically activate a massive number of T-cells
- Similar syndrome can be caused by toxin production of Clostridium sordelli
Criteria
Criteria | Staphylococcal | Streptococcal |
---|---|---|
Confirmed | hypotension + fever + rash + desquamating + 3 or more other | hypotension + 2 or more other |
Hypotension | SBP ≤90 mmHg | SBP ≤90 mmHg |
Fever | temp ≥38.9ºC | |
Skin | diffuse macular erythroderma followed by desquamation | generalized erythematous macular rash that may desquamate |
GI | n/v/d at onset | |
Resp | ARDS | |
MSK | myalgia ± CK ≥2x ULN | soft-tissue necrosis (e.g. nec.fasc) |
Mucosa | hyperemia of any mucosa | |
Nephro | Creatinine ≥2x ULN, or pyuria without UTI |
Creatinine ≥177 or ≥2x ULN or ≥2x baseline |
Hepatic | bili/ALT/AST ≥2x ULN | ALT/AST/bili ≥2x ULN or ≥2x baseline |
Heme | thrombocytopenia <100 | thrombocytopenia ≤100, or DIC (INR/fibrinogen/D-dimer) |
CNS | altered LOC without focal signs |
Management
First-Line | Beta-lactam Allergy | Notes | |
---|---|---|---|
Streptococcus pyogenes | Penicillin G and clindamycin | Macrolide or fluoroquinolone, and clindamycin | Macrolide and fluoroquinolone resistance increasing |
MLS-resistant Streptococcus pyogenes | Penicillin G, and vancomycin or teicoplanin | Vancomycin or teicoplanin | Macrolide resistance associated with clindamycin resistance |
Methicillin-susceptible Staphylococcus aureus | Cloxacillin or nafcillin or cefazolin, and clindamycin | Clarithromycin and clindamycin | |
Methicillin-resistant Staphylococcus aureus | Clindamycin or linezolid, and vancomycin or teicoplanin | ||
Glycopeptide resistant or intermediate Staphylococcus aureus | Linezolid and clindamycin (if susceptible) | Incidence increasing. Geographical patterns highly variable |
Further Reading
- Gram-positive toxic shock syndromes. Lancet Infect Dis. 2009;9(5):281-290. doi: 10.1016/S1473-3099(09)70066-0